Younger exposure to football linked to worse cognitive outcomes in later life

Key takeaways:

• Younger age at first exposure to football in males was associated with worse clinical outcomes in older age.
• Repetitive head injury at a younger age may decrease resilience and coping with neuropathology.

PHILADELPHIA — Among men who played American football, researchers found that exposure to the sport at a younger age was strongly associated with worse cognitive performance and resilience, particularly in those who lived to at least 60 years.

“We know what a positive impact football has in the community, and we want to make sure we know all the risks going in so that parents and children can make informed decisions,” Sophia Nosek, BS, a research specialist at Boston University’s Chronic Traumatic Encephalopathy Center (CTE), told Healio during her poster presentation at the Alzheimer’s Association International Conference. “I think a big gap in our general idea of CTE is how it impacts individuals as each person seems to react a little differently.

Prior research has established that repetitive head contact and head injuries, along with the duration males participate in American football, is directly correlated with greater severity of CTE.

Nosek and colleagues sought to examine the relationship between the earlier age at which young males begin to play the sport with the worsening clinical outcomes and severity of CTE reported later in life.

Their study included data from the UNITE Brain Bank within the CTE Center at the university, selecting the brains of 677 male American football players (mean age of death, 60 years; mean age of first exposure to football [AFE], 11.15 years; 83% white) from an initial cohort of more than 1,000 individuals.

Informants for each of the selected donors — some of whom revealed AFE was as young as 3 years old, Nosek said — were asked to complete a series of scales which assessed the donor’s cognitive function (Cognitive Difficulties Scale [CDS]; Functional Activities Questionnaire; BRIEF-A Meta Cognition Index [MI]), mood (Apathy Evaluation Scale; Beck Anxiety Index; Geriatric Depression Scale-15) and neurobehavioral symptoms (Barratt Impulsiveness Scale; Behavioral Regulation Index; Brown-Goodwin Aggression Scale). Composites from each of the three scales were subdivided between individuals who died younger than 60 years (n = 277) and those who died at 60 years or older (n = 400).

The researchers employed standard logistic regressions analysis to test associations between AFE and each overall scale, scale composite scores, dementia and CTE, with age, duration of play and disease pathology as covariates.

Nosek and colleagues found that in those aged 60 years or older at the time of donation, strong associations existed between younger AFE and worse performance on the CDS, MI and overall worse scores for all three composites.

However, the researchers noted that AFE was not associated with either CTE pathology or dementia status.

“We’re not exactly sure when a recommendation should be (made for) when they start playing, but these are our children we want to protect,” Nosek told Healio. “We predict that youth exposure to head impact might decrease one’s resiliency to coping with neuropathology later in life.